Epilepsy — Lucia Zamorano, MD, PLC

Low Dose Fish Oil Helpful in the Management of Seizures

After several negative trials, the possibility of treating epilepsy with fish oil has seen a glimmer of hope with a new randomized trial suggesting a significant benefit with a lower dose than has previously been tested.

The study, published online September 9 in the Journal of Neurology Neurosurgery & Psychiatry 9 and conducted by a team led by Christopher M. DeGiorgio, MD, Department of Neurology, UCLA School of Medicine, Los Angeles, California, showed a significant reduction in seizure frequency with the low-dose but not the high-dose treatment vs placebo.

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New approved extended release medication for epilepsy

The US Food and Drug Administration (FDA) has approved another once-daily extended-release formulation of topiramate (Qudexy XR, Upsher-Smith Laboratories Inc), the company announced.

It is indicated as initial monotherapy in patients 10 years of age or older with partial-onset seizures or primary tonic-clonic seizures, and also approved as adjunctive therapy in patients 2 years of age or older with partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome.

The new formulation is available in 25-, 50-, 100-, 150-, and 200-mg extended-release capsules, the statement notes. Capsules can be opened and the contents sprinkled on a spoonful of soft food to facilitate dosing. “This makes it the only approved extended-release topiramate product for patients who experience challenges swallowing whole capsules or tablets,” the release adds.

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Epilepsy surgery effective also on patients older than 60

Surgery in older patients with epilepsy has the potential to improve overall health and quality of life, as well as provide a favorable seizure outcome, according to a study presented at the 67th Annual Meeting of the American Epilepsy Society.

Investigators at the University of California, Los Angeles (UCLA), reviewed the records of 10 patients who had undergone resective epilepsy surgery for medically refractory focal onset seizures at their institution between 1992 and 2012. Patients ages 60 and older (age range: 60 to 74) with a minimum follow-up of one year (range 1 to 7.5 years) were included in the study. Comorbidities at the time of surgery, including hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, osteoporosis, obstructive sleep apnea, depression, and falls, were noted. A modified Liverpool life satisfaction tool was administered postoperatively, with a maximum score of 40.

Patients’ mean age at surgery was 65.4. The mean duration of epilepsy before surgery was 27.8 years. At the time of surgery, 70% of patients had at least one medical comorbidity in addition to refractory seizures. No patients experienced any postsurgical complications.

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Important advances in epilepsy and seizure management

A report on long-term outcomes in patients treated with a newly approved electrical therapy for refractory seizures is among the highlights at this year’s American Epilepsy Society annual meeting here.

Also on tap: studies of a new form of laser surgery for seizure ablation, a wearable seizure detector, and a device for home monitoring of anti-epileptic drug blood levels, said Kimford Meador, MD, of Stanford University in Stanford, Calif., the organization’s scientific program committee chairman.

Another study, led by Meador himself, examines whether children of mothers taking the epilepsy drug valproate while breastfeeding suffered adverse consequences at age 6 as a result. (Answer: it was definitely not harmful and may have been beneficial.)

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New implantation device for intractable epilepsy

RNS for Epilepsy Has Long-Term Benefits

More than half of epilepsy patients treated with the recently approved responsive neurostimulation device (RNS) had reductions of 50% from baseline in seizure frequency lasting for up to 80 months, researchers reported here.

Among 250 participants in the pivotal trial of the implanted RNS System neurostimulator, approved last month for treating drug-resistant focal epilepsy, long-term follow-up indicated that responder rates increased steadily over the first 2 to 3 years after implant, reaching about 55%, said Martha Morrell, MD, chief medical officer of NeuroPace, based in Mountain View, Calif., which manufactures the device.

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Subdural Electrodes Beneficial for Epilepsy Monitoring

Brain Epilepsy Surgery By: SHARON WORCESTER, Clinical Neurology News Digital Network

The implantation of subdural electrodes for the treatment of intractable epilepsy is beneficial, but requires careful surveillance during the monitoring period, according to findings from a study of 91 consecutive patients.

This is especially true for those who undergo large subdural grid placement, as these patients have an increased risk for complications, Dr. Fernando L. Vale of the University of South Florida, Tampa, and his colleagues reported online in Clinical Neurology and Neurosurgery.

Of 508 patients who underwent surgical intervention for the evaluation and treatment of medically resistant epilepsy at a single center from 1999 to 2010, 91 (18%) required invasive subdural electrode placement and were included in this study.… [Continue Reading]

Brain Stimulation approved for treatment of Epilepsy and Depression

September 7, 2012 — An external trigeminal nerve stimulation (eTNS) system (Monarch, NeuroSigma, Inc) has received European Union (EU) CE Certification for the adjunctive treatment of epilepsy and major depressive disorder for adults and children aged 9 years and older.

The device has been evaluated in clinical trials conducted at the University of California, Los Angeles (UCLA) and the University of Southern California. It consists of an external pulse generator and disposable electric patches placed on the forehead that are replaced daily and are worn primarily during sleep.… [Continue Reading]

The ERSET Trial of Early Surgery for Mesial Temporal Lobe Epilepsy: Results and Frustrations

Pharmacoresistant epilepsy develops in approximately 25% to 30% of all epilepsy patients.1 Mesial temporal lobe epilepsy (MTLE) patients tend to be most refractory to treatment with antiepileptic drugs (AEDs), accounting for the highest percentage of epilepsy patients without seizure freedom.1 However, despite Wiebe et al demonstrating in a Canadian randomized controlled trial that temporal lobe resection (TLR) led to significantly higher rates of seizure freedom than medical management in patients with MTLE,2 temporal lobe epilepsy surgery remains underutilized. To investigate the potential benefits of early surgical intervention in medically refractory MTLE, the National Institutes of Health (NIH) funded the Early Randomized Surgical Epilepsy Trial (ERSET), the results of which were recently published in JAMA.3… [Continue Reading]

Vagus Nerve, Deep Brain, and Responsive Neurostimulation

John D. Rolston, M.D., Ph.D.; Dario J. Englot, M.D., Ph.D.; Doris D. Wang, M.D., Ph.D.; Tina Shih, M.D.; Edward F. Chang, M.D.

Abstract and Introduction

Epilepsy is a devastating disease, often refractory to medication and not amenable to resective surgery. For patients whose seizures continue despite the best medical and surgical therapy, 3 stimulation-based therapies have demonstrated positive results in prospective randomized trials: vagus nerve stimulation, deep brain stimulation of the thalamic anterior nucleus, and responsive neurostimulation. All 3 neuromodulatory therapies offer significant reductions in seizure frequency for patients with partial epilepsy. A direct comparison of trial results, however, reveals important differences among outcomes and surgical risk between devices. The authors review published results from these pivotal trials and highlight important differences between the trials and devices and their application in clinical use.… [Continue Reading]

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Low Dose Fish Oil Helpful in the Management of Seizures

New approved extended release medication for epilepsy

Epilepsy surgery effective also on patients older than 60

Important advances in epilepsy and seizure management

New implantation device for intractable epilepsy

Subdural Electrodes Beneficial for Epilepsy Monitoring

Brain Stimulation approved for treatment of Epilepsy and Depression

The ERSET Trial of Early Surgery for Mesial Temporal Lobe Epilepsy: Results and Frustrations

Vagus Nerve, Deep Brain, and Responsive Neurostimulation

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